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Clin Med- P > Neuro- HA, facial pain > Flashcards

Neuro- HA, facial pain Flashcards

1
Q

what is common and what is scary? 3 of each

A

common: tension HA, migraine, chronic daily HA (rebound)

scary; inc. ICP (bleeds), pregressive HA (tumor), temporal arteritis (syst. vascular inflamm- threatens eyesight)

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2
Q

what are the new drugs out there for HA/facial pain?

A

CGRP drugs- calcitonin G-peptide

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3
Q

PE or history more important for HA/facial pain?

A

history!

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4
Q

if the HA effects activities of daily living, we are thinking it is…?

A

migraine

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5
Q

young w/ new HA =?

old (>40yo) w/ new HA=?

A

young- migraine

older- red flag!

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6
Q

what patterns do you want to ask about for HA?

A

varying during the day, menses, stress related, clusters

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7
Q

10 red flags for HA

A

progressive HA- tumor?
“Worst of my life” - bleed or inc ICP of other cause
changes in intensity, freq, etc
new HA in older person, new severe HA in adult
meningeal signs
temporal arteritis
HA that disturbs sleep or in morning (pink flag)
cough-induced
w/ focal neuro S&S affecting one side or one part of body
post-lumbar HA-leak?

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8
Q

what percentage of people who present to ER with HA are life-threatening?

A

1%

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9
Q

all types of HA may get better with ___ therapy but it doesnt mean that the HA was a _____

A

migraine therapy, migraine

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10
Q

HA- look for causes that need immediate treatment like…

A 
CO poisoning (heating the house, others have the HA) 
preeclampsia
intracranial mass
infection
vascular
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11
Q

two pts that NEED imaging even if physical is normal

A
  • thundercalp HA, sudden onset - subarachnoid hemorrhage?

- HIV or elderly (esp w/ new HA) - infection?

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12
Q

temperature elevated with HA? think…
high BP with HA? think…
>50yo tender scalp w/ HA? think…

A

meningitis
HTN, preeclampsia, pheochromocytoma
temporal arteritis

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13
Q

what two tests will you do for possible meningitis?

A

kernig’s - flex hip- extend knees and pain

brudzinski’s- flex neck, hand on chest, knee and hip flexion are a positive sign

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14
Q

HA and abnormality with visual or neuro test.. follow with?

A

imaging

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15
Q

who will you image scan urgently?

A
  • first and worst HA
  • abnormal neuro
  • abnormal mental status
  • abnormal fundoscopy- papilledema
  • meningeal signs
  • new HA - 50yo+
  • HIV
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16
Q

CT vs MRI scan

A

CT for acute eval of “worst HA ever” (fresh bleed, w/in 24 hrs)
MRI- scan of choice for all others (MRA- (angiography) for select cases)

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17
Q

patterns of HA:

migraine, tension, cluster, brain tumor

A

migraine: sporatic pattern
tension: constant, consistent, low level
cluster: clustered groups
tumor: progressively worsening

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18
Q

triggers- anything that causes pain above the neck can cause a ___

A

migraine

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19
Q

HA that start in the the back and improves with physical manipulation

A

tension HA

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20
Q

neurokinin

A

pro-inflammatory relative of bradykinin that causes pain

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21
Q

anything that causes ____ can cause a HA

A

vasodilation

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22
Q

“periodic, debilitating HA assosciated w/ N/V” is often what?

A

migraine

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23
Q

migraines have ____, often to multiple stimuli and in multiple systems like _____

A

hypersensitivities , GI/IBS

24
Q

old migraine theory vs new migraine theory

A

old: vasoconstriction followed by reactive vasodilation
new: still partly vascular but brain is involved
- ->trigeminal hypersens, innervation of cranial vessels and dura w/ inflamm changes

25
Q

migraine w/out aura: IHS criteria

A

HA 4-72 hours w/ 2-4 of …unilateral pain, throbbing, moderatoe –> severe, worse w/ routine activity
and 1 of …N/V, photophobia/phonophobia
-w/ 5 previous attacks

26
Q

migraine w/ aura: IHS criteria

A

HA after aura, aura has 3 of the following….

  • 1+ reversible symptoms indicating dysfunction
  • develops gradually w/ more symptoms
  • no symp >60min
  • HA w/in 60 min
27
Q

w/out aura vs w/ aura: percentages

A

with aka classic = 20%

without aka common = 80%

28
Q

location of pain for migraines and timing

A

usually lateral but can be bilateral, build up slowly and last hours

29
Q

what is an aura?

A

focal disturbances of neuro function- preceding or accompanying pain

  • visual: field deficits and flashing lights, often side opposite the pain
  • aphasia, numbness, tingle, clumbsy
  • generally resolves before or with pain
30
Q

rarely get ____ and no migraine

A

aura

31
Q

aura equals double risk for what?

A

stroke - but baseline risk is usually low

32
Q

critical parts of PE for migraine

A

vitals, neuro, vision w/ fundoscope

-most likely a normal exam

33
Q

what migraine will you do labs for?

A

the first one

34
Q

TXT for migraine HA

A
  • NSAIDs (naproxen) > APAP (tylenol)
  • sleep
  • vasoconstrictors (ergots, caffeine)
  • Triptans (1st LINE! )
  • antipsyc-related Rx
35
Q

triptans for migraines

A
  • expensive
  • sumatriptan: shortest onset but most ADRs (short 1/2 life = rebound HA)
  • injected IV/SC better than oral or nasal
  • work better if used in prodrome
36
Q

how to take triptans

A

take as soon as you know its going to be a migraine

  • GOAL: headache is GONE not reduced
  • if HA not gone in 2 hrs, take another dose, repeat every 2 hours up to max daily dose
37
Q

which triptan has the longest half life?

A

fovatriptan

38
Q

when do you use prophylaxis for migraines?

A

if >4 in one month

39
Q

what to use for prophylaxis for HA?

A 
#1- amitriptyline @ 10mg (TCA)- it lowers BP (careful w/ older people) 
any anti-HTN  (beta or ca+ blocks)
-gabapentin, anti-convulsants
-SSRIs 
-avoid triggers and excercise
40
Q

new mab drugs for migraine - what do they target and how often do you take?

A

3 new ones, target either CGRP or its receptors

  • infusions every 3 months
  • b/c they are antibodies, you can develop an immune response to them and then it wont be effective
41
Q

tension HA: how do they present, what are they caused by, what do you treat them with

A
  • band-like from muscle tension w/ vasodilation secondary to inflamm mediators
  • worsen throughout the day
    txt: triptans for severe, prophylaxis, fix stress
42
Q

chronic use of sinus medication may cause…

A

rebound HA

43
Q

“scary” sinus HA

A

erosion of sinuses into CNS –> brain abscess

need immediate attention

44
Q

cluster HA

A

men, unilateral, transient , severe-incapacitating

  • may pound on their head
  • not throbbing
  • ipsilateral nasal congestion, redness, tearing, horner’s syndrome (ptosis- interruption of sympathetic tone)
45
Q

cluster vs migraine: prevalence, gender, onset, location, duration, time of day, activity

A

prevalence: C- low, M-higher
gender: C- males M-females
onset: C- sudden M-gradual
location: C- retro-orbital, M- uni or bilateral
duration: C-short M-4-72 hours
time of day: C- night M-any
activity: C-pacing, pounding on head, M-bedrest

46
Q

Txt for cluster HAs

A

usually ineffective

  • 100% O2
  • triptans, ergots
  • Ca+ channel blockers (verapamil)
  • indomethacin
47
Q

horner’s syndrome is due to impaired…

A

sympathetic innervation to the eye and nearby skin glands

48
Q

what is a transformed migraine?

A

chronic daily HA that started as a migraine, can originate as a tension HA
-usually w/ daily HA drug use (from any drug used to treat HA including decongestants)

49
Q

txt for transformed migraine

A 
#1- stop daily meds
#2- prophylaxis, may take a month
-never will get complete reliefe
50
Q

anticonvulsants for neuropathic pain- trigeminal neuralgia and chronic pain/diabetic neuropathy/postherpetic ?

A

tegretol (carbamazepine) for trigeminal neuralgia

low dose amitryptyline for chronic pain/DM/postherpetic

51
Q

what drug is like amytriptyline but expensive?

A

neurontin (gabapentin)

52
Q

what causes neuropathic pain?

A

excessive neural activity esp. on SNS pathways

53
Q

what CN is affected by post-herpetic neuralgia?

A

CN V branch 1 (superior branch)

54
Q

temporal arteritis

A

syst. vascular inflamm condition of an unknown cause
- tenderness in arteries, esp temporal
- hypercoag
- can cause retinal occlusion and blindness
- wont really see in anyone younger than 50yo

55
Q

what may you see unliteral HA and jaw claudication with ? what is jaw claudication?

A

temporal arteritis

-dec arterial flow to jaw muscles = ischemia

56
Q

temporal arteritis management

A

oral prednisone w/ slow taper- monitor ESR/CRP (inc sed rate- erythrocyte and c-protein)

  • opthamology consult- urgent
  • temporal artery biopsy before steroids take effect

Clin Med- P (124 decks)

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